Reimagining the Virtual Patient. Crafting Game-Inspired Interactive Stories for Compassion Training

Abstract

Interactive stories for learning (ISL) are a powerful pedagogical approach, well supported by learning theory and scholarly research. Learners traverse a story which reflects their real-life environment, make decisions and explore diverse narrative paths, learning from the consequences of their actions. It is a safe space for learners to practice, where failures function as learning opportunities. Despite their potential, ISL often fail to engage learners effectively due to poor execution. Learning designers face the challenge of ensuring narrative engagement while enhancing learner capability, but may lack the necessary skills to craft high-quality interactive stories. This gap is particularly clear when the ISL deals with intricate human interactions, such as healthcare provider-patient conversations. Scholars advocate for better narratives to enhance the potential of ISL in healthcare – referred to as virtual patients – for teaching non-technical skills, including empathy and compassionate care. However, crafting advice is scarce and fragmented, and too focused on learning from linear, not interactive storytelling.

This study endeavoured to enhance ISL by learning the craft from narrative design in video games, where expertise and innovation in producing high-quality interactive narratives has been fostered since the earliest games, more than 50 years ago. In the first phase of this research, disseminations from narrative design experts were collected, analysed and synthesised. The expert advice emphasised the pivotal role of emotions and player self-expression in crafting interactive narrative, along with the importance of designing believable characters and meaningful choices. A comprehensive heuristics framework to craft ISL was developed based on the insights from this phase. Through iterative prototyping and reflection, the heuristics framework was evaluated and refined, and subsequently applied to the recrafting of a virtual patient for compassion training. The recrafted and original version were presented to nurses in the final phase of this study. An online survey measured the participants’ narrative transportation in the virtual patient story and asked about their learner experience. Additionally, their decision-making during playthroughs was recorded.

While no statistically significant differences for narrative transportation were found, the results from the playthrough data and open-ended questions demonstrated that incorporating emotional depth into virtual patient design significantly impacted learner engagement and empathy. Participants exhibited more compassionate care when interacting with the recrafted virtual patient, showing highly improved decision-making to promote patient outcomes.

This study contributes valuable insights into leveraging game narrative techniques to enhance the crafting of virtual patients for compassionate care training. By bridging the gap between learning design and game narrative expertise, educators can create more immersive and effective ISL experiences, ultimately enhancing learner outcomes and experiences.